Malaria has no effect on birth weight in Rwanda

Malaria has no effect on birth weight in Rwanda Rulisa, S.; Mens, P.F.; Karema, C.; Schallig, H.D.F.H.; Kaligirwa, N.; Vyankandondera, J.; de Vries, P.J. Published in: Malaria Journal DOI: 10. 1186/1475-2875-8-194 Link to publication Citation for published version (APA): Rulisa, S., Mens, P. F., Karema, C., Schallig, H. D. F. H., Kaligirwa, N., Vyankandondera, J., & de Vries, P. J. (2009). Malaria has no effect on birth weight in Rwanda. Malaria Journal, 8, 194. https://doi.org/10.1186/1475-2875 General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Abstract Background: Malaria has a negative effect on pregnancy outcome, causing low birth weight, premature birth and stillbirths, particularly in areas with high malaria transmission. In Rwanda, malaria transmission intensity ranges from high to nil, probably associated with variable altitudes. Overall, the incidence decreased over the last six years (2002)(2003)(2004)(2005)(2006)(2007). Therefore, the impact of malaria on birth outcomes is also expected to vary over time and space

Community mobilization for malaria elimination: application of an open space methodology in Ruhuha sector, Rwanda

Background Despite the significant reduction of malaria transmission in Rwanda, Ruhuha sector is still a highly endemic area for malaria. The objective of this activity was to explore and brainstorm the potential roles of various community stakeholders in malaria elimination. Methods Horizontal participatory approaches such as ‘open space’ have been deployed to explore local priorities, stimulate community contribution to project planning, and to promote local capacity to manage programmes. Two open space meetings were conducted with 62 and 82 participants in years 1 and 2, respectively. Participants included purposively selected community and local organizations’ representatives. Results Malaria was perceived as a health concern by the respondents despite the reported reduction in prevalence from 60 to 20% for cases at the local health centre. Some misconceptions of the cause of malaria and misuse of preventive strategies were noted. Poverty was deemed to be a contributing factor to malaria transmission, with suggestions that improvement of living conditions for poor families might help malaria reduction. Participants expressed willingness to contribute to malaria elimination and underscored the need for constant education, sensitization and mobilization towards malaria control in general. Active diagnosis, preventative strategies and prompt treatment of malaria cases were all mentioned by participants as ways to reduce malaria. Participants suggested that partnership of stakeholders at various levels could speed up programme activities. A community rewards system was deemed important to motivate engaged participants, i.e., community health workers and households. Establishment of malaria clubs in schools settings was also suggested as crucial to speed up community awareness and increase skills towards further malaria reduction. Conclusions This bottom-up approach was found useful in engaging the local community, enabling them to explore issues related to malaria in the area and suggest solutions for sustainable malaria elimination gains

Population pharmacokinetics of artemether, dihydroartemisinin and lumefantrine in Rwandese pregnant women treated for uncomplicated Plasmodium falciparum malaria

The artemisinin-based combination therapy artemether-lumefantrine is commonly used in pregnant malaria patients. However, the effect of pregnancy-related changes on exposure is unclear and pregnancy has been associated with decreased efficacy in previous studies. This study aimed to characterize the population pharmacokinetics of artemether, its active metabolite dihydroartemisinin, and lumefantrine in 22 Rwandese pregnant women of second (n=11) and third trimester (n=11) with uncomplicated Plasmodium falciparum malaria. These patients were enrolled from Rwamagana district hospital and received the standard fixed oral dose combination of 80 mg artemether and 480 mg lumefantrine twice daily for three days. Venous plasma concentrations were quantified for all three analytes using liquid chromatography coupled to tandem mass spectroscopy and data analyzed using nonlinear mixed-effects modelling. Lumefantrine pharmacokinetics was described by a flexible but highly variable absorption, with a mean absorption time of 4.04 hours, followed by a bi-phasic disposition model. The median AUC0-∞ for lumefantrine was 641 h.mg/L. Model-based simulations indicated that 11.7% of the study population did not attain the target day 7 plasma concentration (280 ng/mL), a threshold associated with increased risk of recrudescence. Pharmacokinetics of artemether was time-dependent and the auto-induction of its clearance was described using an enzyme turnover model. The turnover half-life was predicted to be 30.4 hours. The typical oral clearance, which started at 475.7 L/hr, increased 1.43 fold at the end of treatment. Simulations suggested that lumefantrine pharmacokinetic target attainment appeared reassuring in Rwandese pregnant women, particularly compared to target attainment in Southeast Asia. Larger cohorts will be required to confirm this finding

Population pharmacokinetics of artemether, dihydroartemisinin and lumefantrine in Rwandese pregnant women treated for uncomplicated Plasmodium falciparum malaria

The artemisinin-based combination therapy artemether-lumefantrine is commonly used in pregnant malaria patients. However, the effect of pregnancy-related changes on exposure is unclear and pregnancy has been associated with decreased efficacy in previous studies. This study aimed to characterize the population pharmacokinetics of artemether, its active metabolite dihydroartemisinin, and lumefantrine in 22 Rwandese pregnant women of second (n=11) and third trimester (n=11) with uncomplicated Plasmodium falciparum malaria. These patients were enrolled from Rwamagana district hospital and received the standard fixed oral dose combination of 80 mg artemether and 480 mg lumefantrine twice daily for three days. Venous plasma concentrations were quantified for all three analytes using liquid chromatography coupled to tandem mass spectroscopy and data analyzed using nonlinear mixed-effects modelling. Lumefantrine pharmacokinetics was described by a flexible but highly variable absorption, with a mean absorption time of 4.04 hours, followed by a bi-phasic disposition model. The median AUC0-∞ for lumefantrine was 641 h.mg/L. Model-based simulations indicated that 11.7% of the study population did not attain the target day 7 plasma concentration (280 ng/mL), a threshold associated with increased risk of recrudescence. Pharmacokinetics of artemether was time-dependent and the auto-induction of its clearance was described using an enzyme turnover model. The turnover half-life was predicted to be 30.4 hours. The typical oral clearance, which started at 475.7 L/hr, increased 1.43 fold at the end of treatment. Simulations suggested that lumefantrine pharmacokinetic target attainment appeared reassuring in Rwandese pregnant women, particularly compared to target attainment in Southeast Asia. Larger cohorts will be required to confirm this finding